Form Vs-8 - Declaration Of Paternity - Kentucky State Registrar Of Vital Statistics
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1
2COMMONWEALTH OF KENTUCKY
VS-8 (Rev 1-02)
State Registrar of Vital Statistics
DECLARATION OF PATERNITY
FATHER’S AFFIDAVIT
Pursuant to KRS 213.046, I, _____________________________________________, having been duly sworn do hereby
(Full Name of Father)
state, affirm, and acknowledge that I am the natural father of a ______________________ child, named
(Sex)
______________________________________________________________ born on ____________________________
(Full Name of Child at Birth)
(Month)
(Day)
(Year)
at _____________________________________________________________________________________ , Kentucky.
(
Hospital)
(City)
(County)
My date of birth is ____________________________. I was born in _________________________________________.
(Month)
(Day)
(Year)
(City)
(State)
My highest grade of education completed was ____. My race is ___________________. I am of Hispanic Origin ______.
(Yes/No)
(If yes, specify) ___________________________. My Social Security Number is __________________________.
(Cuban, Mexican, etc.)
My current address is _______________________________________________________________________________.
(Street & Number, Apt. Number, City, State, Zip Code)
I HAVE READ AND UNDERSTAND MY RIGHTS AND RESPONSIBILITIES LISTED ON THE REVERSE SIDE.
_____________________________________________
(Father’s Signature)
Subscribed and sworn to before me on this the _____ day of ______________________________________ 20 _______
_________________________________
____________________________________________________
My Commission Expires
Notary
MOTHER’S AFFIDAVIT
I, ____________________________________________, having been duly sworn do hereby state, affirm, and
(Full Name of Mother)
acknowledge that I am the natural mother of the above said child and that ______________________________________,
(Father’s Name)
the above affiant, is the natural father of said child. My maiden name is ________________________________________.
My date of birth is ______________________________. My Social Security Number is __________________________.
(Month)
(Day)
(Year)
My current address is _______________________________________________________________________________.
(Street & Number, Apt. Number, City, State, Zip Code)
CHILD’S NAME SHOULD READ ___________________________________________________________________
I HAVE READ AND UNDERSTAND MY RIGHTS AND RESPONSIBILITIES LISTED ON THE REVERSE SIDE.
______________________________________________
(Mother’s Signature)
Subscribed and sworn to before me on this the _________ day of __________________________________ 20 ________
_________________________________
_____________________________________________________
My Commission Expires
Notary
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